The short answer
If you've used a drug manufacturer's copay card to lower the cost of a brand-name medication before Medicare, you may be surprised to learn you generally can't use those cards once you're on a Medicare drug plan. Federal rules prohibit using manufacturer copay coupons with Medicare Part D. It's a frustrating change for people who relied on them.
The good news is there's an alternative designed for exactly this situation: charitable patient-assistance programs.
Why the rule exists
Manufacturer copay cards are considered a form of inducement that federal programs like Medicare don't allow, to avoid steering people toward pricier brand drugs at taxpayer expense. So even if a card worked wonders on your employer plan, it won't apply once you're in Part D. This catches a lot of people moving from employer coverage to Medicare on an expensive brand drug.
It's not your plan being difficult — it's a federal rule that applies across Medicare. Our guide to how Medicare covers specialty and high-cost drugs covers options for pricey medications.
What can help instead
Independent charitable patient-assistance foundations can help Medicare beneficiaries with the cost of certain drugs, and they are allowed where manufacturer copay cards are not. Manufacturers also sometimes have separate assistance programs for people who can't afford a drug. And the annual Part D out-of-pocket cap now limits your total yearly drug spending.
So if losing a copay card leaves you facing a high cost, don't assume there's no help — there often is. Our government help center points to assistance resources.
Frequently Asked Questions
Can I use a drug copay card with Medicare?
Generally no. Federal rules prohibit using manufacturer copay coupons with Medicare Part D, even if the card worked on your previous employer plan.
Why can't I use copay cards on Medicare?
Manufacturer copay cards are treated as an inducement that federal programs like Medicare don't allow, to avoid steering people toward pricier brand drugs at taxpayer expense.
What can help if I can't use a copay card?
Independent charitable patient-assistance foundations can help Medicare beneficiaries with certain drug costs, some manufacturers have separate assistance programs, and the annual Part D out-of-pocket cap limits your total spending.
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